| NPI | 1639995780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TE1100X Psychologist, Exercise & Sports (Licence: CA 33061) |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: CA 33061) |
| 103TC0700X Psychologist, Clinical (Licence: CA 33061) | |
| Enumeration Date | 2024-11-22 |
| Last Update Date | 2024-11-22 |